There are so many varieties of hepatitis – the many viruses, drug-related, alcohol, parasites, ischaemia…and of course, autoimmune. After the recent wave of immunosuppressive therapies over the last decade, what’s the deal?
- affects more women that men
- often has no identifiable precipitant, but sometimes preceded by a virus or new drug
- presents as persistently abnormal ALT or AST with hyperglobulinaemia
- 25% asymptomatic at diagnosis, and can be can be acute or chronic in nature
- diagnosis made with a combination of
- high ALT/AST
- raised serum Ig
- high IgA makes you think of steatohepatitis
- high IgM classically associated with PBC
- negative tests for viral hepatitis
- high Ab
- Anti smooth muscle
- clinical features
- types (check out table 2 in the article
- presence of ANA (homogenous) or anti-smooth muscle
- anti -SLA/LP is specific, but only present in 10-30% of cases
- anti-LKM1 or anti LC1
Check out the tables with the diagnostic criteria and scoring systems. The article also provides a nice overview of treatment, with an algorithm presented to simplify matters.
- treatment usually starts with prednisolone and azathioprine (remember to check TPMT first!)
- liver biopsy can be used to monitor treatment
- mycophenolate is an alternative if azathioprine is not tolerated
- keep transplantation in the back of your mind
It’s a well written article, and most certainly worth the ten minute read – and copy some of those tables and diagrams into your own notes for later. Check it out at Gut, here.